Over 2/3 of the cases of AIDS in women in the United States are a result of the abuse of intravenous drugs. As the number of adults infected with HIV has increased, there has been a parallel increase in the number of pediatric patients with HIV infection, the majority of which are offspring of HIV infected IV drug abusing (IVDA) women. The goal of this research is to identify early and specific HIV related abnormalities in immune functions and CNS development in children born to HIV infected IVDA women. Our specific aims are: to detect HIV infection in newborns, and identify early prognostic markers of disease progression; to measure subtle immune abnormalities in HIV infected infants and understand the earliest stages of the pathogenesis of the immunodeficiency; and to investigate the early developmental and neurologic consequences of HIV infection, and to determine the detrimental effects of maternal HIV infection on uninfected offspring. To achieve these aims, we will continue our prospective study of infants of HIV infected and uninfected IVDA women, but focus on the first 6 months of life. We will evaluate several strategies for the sensitive and specific diagnosis of HIV infection in newborns including: HIV culture from CD8-depleted lymphocytes, evaluate parameters of polyclonal B cell activation, and quantitate secretory IgA. Finally, we will define the spectrum of and the essential diagnostic criteria for neurologic disease in infants with HIV, identify specific early prognostic markers, and define those the deleterious effects of maternal HIV infection on uninfected infants. These studies will characterize HIV infection in children of IVDA women and provide the basis for developing and testing specific therapeutic interventions.